内容紹介
Opioid Induction Using Rapid Release Drugs and the Shift to Fentanyl Patches
Summary
Subject and methods: From April 2011 to March 2013, 20 patients with cancer pain that was not controlled by non-opioid analgesics were treated with a short-acting opioid for cancer pain management. The primary carcinoma sites were the stomach(n=5), colo-rectum(n=5), lungs(n=3), urinary bladder(n=2), breast(n=2), pancreas(n=2), and liver(n=1). The analgesic effects and adverse events were evaluated, and a shift to fentanyl patches was made for patients whose cancer pain was relieved. After the shift, the efficiency and safety were validated. Results: All 6 patients with a numeric rating scale(NRS)less than 5 at the time of opioid induction had a good analgesic effect, and in only 1 patient, grade 2 constipation and grade 3 anorexia was observed. Of the 14 patients who had an NRS of 6 or greater, 11 had a good analgesic effect. However, 3 patients experienced no effect, and their survival periods after opioid induction were very short. In the 11 patients with good pain control, only 3 patients exhibited grade 2 adverse events. Nine patients out of 17 with a good analgesic effect caused by short-acting opioids were shifted to fentanyl patches, and 8 patients were under good analgesic control for 2 weeks or more. Conclusion: Opioid induction using rapid release drugs was effective and safe. However, these drugs should be clinically considered at an early stage. Furthermore, in patients where a shift to a fentanyl patch was possible, good long-term pain control was achieved.
要旨
対象と方法: 2011年4月から2年間に非オピオイド鎮痛薬で十分な鎮痛効果が得られない癌性疼痛患者20名を対象とし,速放性オピオイド鎮痛薬の使用を開始した。原疾患は胃癌5例,大腸癌5例,肺癌3例,膀胱癌2例,乳癌2例,膵臓癌2例,肝癌1例。鎮痛効果,有害事象を評価し鎮痛効果が安定したと考えられた時点でフェンタニルパッチを開始し,有効性,安全性を評価した。結果: 速放性オピオイド鎮痛薬導入時の疼痛がnumeric rating scale(NRS)で5以下であったのが6例であった。その全例で良好な鎮痛効果が得られ,grade 2以上の有害事象は1例のみ(便秘,食欲不振)であった。NRS 6以上であったのは14例で,うち11例で良好な鎮痛効果が得られたが,3例はほとんど鎮痛効果が得られなかった。この3例は導入後早期死亡例であった。有効例11例のgrade 2以上の有害事象は眠気1例,便秘1例,食欲不振1例であった。速放性オピオイド鎮痛薬による鎮痛効果が安定したと考えられた17例のうちフェンタニルパッチに移行したのは9例で,うち8例において2週間以上良好な鎮痛効果が得られた。考察: 速放性オピオイド鎮痛薬を用いたオピオイド導入は有効かつ安全と考えられた。ただし,導入時の疼痛が高度の場合は良好な鎮痛効果が得られにくく病状の進行も早い症例が多いため,臨床的に早期にオピオイド導入を検討すべきであると考えられた。また,フェンタニルパッチに移行可能であった場合,長期の疼痛コントロールが得られ,早期の移行は有用であると考えられた。
目次
Summary
Subject and methods: From April 2011 to March 2013, 20 patients with cancer pain that was not controlled by non-opioid analgesics were treated with a short-acting opioid for cancer pain management. The primary carcinoma sites were the stomach(n=5), colo-rectum(n=5), lungs(n=3), urinary bladder(n=2), breast(n=2), pancreas(n=2), and liver(n=1). The analgesic effects and adverse events were evaluated, and a shift to fentanyl patches was made for patients whose cancer pain was relieved. After the shift, the efficiency and safety were validated. Results: All 6 patients with a numeric rating scale(NRS)less than 5 at the time of opioid induction had a good analgesic effect, and in only 1 patient, grade 2 constipation and grade 3 anorexia was observed. Of the 14 patients who had an NRS of 6 or greater, 11 had a good analgesic effect. However, 3 patients experienced no effect, and their survival periods after opioid induction were very short. In the 11 patients with good pain control, only 3 patients exhibited grade 2 adverse events. Nine patients out of 17 with a good analgesic effect caused by short-acting opioids were shifted to fentanyl patches, and 8 patients were under good analgesic control for 2 weeks or more. Conclusion: Opioid induction using rapid release drugs was effective and safe. However, these drugs should be clinically considered at an early stage. Furthermore, in patients where a shift to a fentanyl patch was possible, good long-term pain control was achieved.
要旨
対象と方法: 2011年4月から2年間に非オピオイド鎮痛薬で十分な鎮痛効果が得られない癌性疼痛患者20名を対象とし,速放性オピオイド鎮痛薬の使用を開始した。原疾患は胃癌5例,大腸癌5例,肺癌3例,膀胱癌2例,乳癌2例,膵臓癌2例,肝癌1例。鎮痛効果,有害事象を評価し鎮痛効果が安定したと考えられた時点でフェンタニルパッチを開始し,有効性,安全性を評価した。結果: 速放性オピオイド鎮痛薬導入時の疼痛がnumeric rating scale(NRS)で5以下であったのが6例であった。その全例で良好な鎮痛効果が得られ,grade 2以上の有害事象は1例のみ(便秘,食欲不振)であった。NRS 6以上であったのは14例で,うち11例で良好な鎮痛効果が得られたが,3例はほとんど鎮痛効果が得られなかった。この3例は導入後早期死亡例であった。有効例11例のgrade 2以上の有害事象は眠気1例,便秘1例,食欲不振1例であった。速放性オピオイド鎮痛薬による鎮痛効果が安定したと考えられた17例のうちフェンタニルパッチに移行したのは9例で,うち8例において2週間以上良好な鎮痛効果が得られた。考察: 速放性オピオイド鎮痛薬を用いたオピオイド導入は有効かつ安全と考えられた。ただし,導入時の疼痛が高度の場合は良好な鎮痛効果が得られにくく病状の進行も早い症例が多いため,臨床的に早期にオピオイド導入を検討すべきであると考えられた。また,フェンタニルパッチに移行可能であった場合,長期の疼痛コントロールが得られ,早期の移行は有用であると考えられた。